Yoshiaki Kiuchi

Background Glaucoma is a progressive optic neuropathy characterized by retinal ganglion cell loss and visual field deterioration. In addition to intraocular pressure, vascular dysregulation and impaired microcirculation may contribute to disease progression. Periorbital skin features may reflect systemic circulatory and tissue changes associated with glaucoma. This pilot study investigated changes in intraocular pressure, periorbital skin texture and color, and peripheral microcirculation in patients with glaucoma receiving Kampo medicine alongside conventional therapy. Methods Fifteen patients with glaucoma received individualized Kampo treatment for 5–7 months while continuing their usual glaucoma medications. Periorbital images were captured with a digital single-lens reflex camera and analyzed using MATLAB-based texture analysis and independent component analysis. Peripheral microcirculation at the forearm was assessed with the Oxygen-to-See system at tissue depths of 2 and 8 mm. Pre- and post-treatment values were compared using paired t-tests or Wilcoxon signed-rank tests, with false discovery rate correction for multiple comparisons. Results Intraocular pressure decreased significantly in both eyes. Superficial blood flow volume at 2 mm increased significantly after false discovery rate correction. Several left periorbital skin parameters showed nominal pre–post changes but were no longer significant after correction. Exploratory subgroup analyses suggested increased superficial flow velocity with Keishibukuryogan and decreased superficial hemoglobin concentration with Hachimigan. Conclusions Kampo treatment combined with conventional therapy was associated with reduced intraocular pressure and changes in peripheral microcirculation and periorbital skin characteristics. These preliminary findings require confirmation in larger controlled studies.

Mechanical stress has been implicated in retinal pigment epithelium (RPE) dysfunction and angiogenic signaling in retinal disorders; however, its direct in vivo effects on the RPE–choroid complex remain incompletely understood. Here, we established a mouse model of localized mechanical stress by subconjunctival implantation of glass beads (0.8–1.2 mm in diameter) in eight-week-old C57BL/6J mice to induce transscleral stretching of the RPE. Ocular tissues were analyzed two days after implantation using histological, immunohistochemical, and molecular approaches, and inflammatory mediators were quantified by multiplex cytokine assays. Mechanical stress induced focal serous retinal detachment, elongation of photoreceptor outer segments, and disruption of the RPE tight junction protein ZO-1. VEGF expression in the RPE–choroid complex was significantly upregulated and accompanied by increased levels of inflammatory mediators, including MCP-1. Intravitreal administration of anti-VEGF agents effectively suppressed stress-induced VEGF expression. These findings indicate that mechanical stress is sufficient to induce structural disruption and angiogenic signaling in the RPE in vivo, providing a useful experimental platform for investigating stress-related retinal responses and therapeutic modulation of VEGF signaling.

Objectives: Caregivers play an important role in providing oral hygiene to individuals with severe disabilities. However, few studies have evaluated the effect of toothbrushing by caregivers. Thus, this study aimed to compare the effects of toothbrushing by caregivers using sonic‐powered and manual toothbrushes on oral hygiene in individuals with severe disabilities. Methods: This was arandomized, single‐blind (investigator), 32‐week clinical trial. A total of 41 patients (25 males, mean age 33.5 years) were included in the study. Patients were randomly assigned to two groups: the sonic‐powered and manual toothbrush groups. The primary outcome variable was periodontal inflamed surface area (PISA). Oral bacterial count (OBC), gingival index (GI), plaque index (PLI), and plaque control record (PCR) were considered secondary outcome variables. Outcome variables and adverse effects were assessed at baseline and 32 weeks after caregivers began using the assigned toothbrush for brushing. Results: In both toothbrush groups, OBC, PISA, GI, PLI, and PCR significantly decreased after the intervention compared with those before the intervention ( p < 0.05). There were no significant differences in the time spent brushing teeth or the burden on caregivers before and after the intervention. Furthermore, no significant differences in OBC, PISA, GI, PLI, and PCR were observed between the two toothbrushes, and no relevant adverse effects were observed. Conclusion: In toothbrushing by caregivers for severely disabled individuals, sonic‐powered toothbrushes were as effective and safe as manual toothbrushes. The results of this study may help caregivers select appropriate toothbrushes when assisted brushing for the severely disabled.

Purpose: Central corneal thickness (CCT) has been reported to be thicker in aphakic and pseudophakic eyes after congenital cataract surgery. We aimed to investigate the factors influencing preoperative CCT and changes in CCT after cataract surgery. Methods: We included 62 eyes of 39 patients with congenital cataracts who underwent cataract surgery at Hiroshima University between February 2006 and July 2022. Pre- and postoperative CCT were measured using a noncontact specular microscope or ultrasound pachymeter. Cataracts were categorized into five morphologies: anterior, posterior, nuclear, total, and others (aculeiform, calcific, cortical, lamellar, pulverulent, and membranous). Statistical analyses were conducted using JMP software, with significance set at P < 0.05. Results: No significant differences in CCT were observed between bilateral and unilateral cataracts or between operated and fellow eyes with unilateral cataracts. However, when cataracts were categorized according to morphology into five categories, namely, anterior cataract, posterior cataract, nuclear cataract, total cataract, and others, the others group exhibited significantly thicker CCT than did the control group (566.6 ± 76.2 µm vs. 525.9 ± 31.2 µm, P = 0.032). Preoperative CCT decreased inversely with age. Postoperative CCT increased significantly compared with preoperative measurements (544.0 ± 35.9 µm vs. 534.5 ± 28.4 µm, P = 0.021). Conclusion: This study highlights that congenital cataract of specific morphologies, particularly those classified in the others group, affect CCT. Preoperative CCT decreased with age. The increase in postoperative CCT suggests that surgical intervention can affect corneal thickness.

Rationale: The aim of this study was to evaluate the clinical outcomes and recurrence patterns of proton beam therapy for choroidal hemangioma–associated retinal detachment in patients with Sturge–Weber syndrome, addressing the limitations of conventional treatments and further elucidating posttreatment recurrence patterns. Patient concerns: Three patients with Sturge–Weber syndrome presented with retinal detachment secondary to diffuse choroidal hemangioma, refractory to standard therapies. Diagnoses: All patients were diagnosed with choroidal hemangioma complicated by subretinal fluid accumulation and retinal detachment in the context of Sturge–Weber syndrome. Interventions: Each patient underwent targeted proton beam therapy directed at the choroidal hemangioma. Outcomes: In all 3 cases, subretinal fluid gradually decreased and ultimately resolved. One patient experienced initial tumor thinning followed by a subsequent increase in hemangioma thickness accompanied by reappearance of subretinal fluid, indicating recurrence. Lessons: Proton beam therapy appears to be an effective treatment modality for retinal detachment associated with choroidal hemangioma in Sturge–Weber syndrome. However, an increase in hemangioma thickness after initial response signals a risk of recurrence; therefore, regular optical coherence tomography and B-mode ophthalmic ultrasound examinations are essential for early detection and timely intervention.

This study aimed to assess ginger extract’s impact on ocular and peripheral blood flow and its potential to alleviate eye fatigue and shoulder stiffness. This study included 100 healthy individuals aged 20–73 years with eye fatigue and shoulder stiffness. Participants were randomly assigned to receive either placebo capsules or ginger extract capsules daily for eight weeks. Ocular blood flow, peripheral blood flow, eye fatigue (visual analog scale [VAS]), shoulder stiffness (VAS), body warmth (VAS), and shoulder muscle stiffness were assessed at weeks 0, 4, and 8, respectively. No improvement in ocular blood flow was observed under the study conditions. Conversely, peripheral blood flow in deep areas was enhanced in females (p = 0.033). Subgroup analysis by age (≥51 or p = 0.017). Similarly, subjective complaints of eye fatigue and shoulder stiffness were improved by ginger consumption in females under 51. Body warmth was favorably changed significantly in males ≥51 years due to ginger consumption. The muscle stiffness showed no statistically significant changes. In conclusion, ginger consumption reduces eye fatigue and shoulder stiffness by enhancing peripheral blood flow in relatively young females.

Background/Objectives: This study aimed to examine the postoperative changes in the corneal biomechanical properties between solo cataract surgery and solo microhook ab interno trabeculotomy (LOT). Methods: This retrospective case–control study included 37 eyes belonging to 26 patients who underwent solo cataract surgery and 37 eyes belonging to 31 patients who underwent solo µLOT. These two groups were matched according to their preoperative intraocular pressure (IOP), axial length (AL), and age. Corneal Visualization Scheimpflug Technology (Corvis ST) was used to obtain four biomechanical parameters representing the corneal stiffness or corneal deformation at the highest concavity, including stiffness parameter A1 (SP-A1), stress–strain index (SSI), peak distance (PD), and deflection amplitude max (DefAmpMax). These parameters were compared preoperatively and 6 months postoperatively, and between the two surgical groups. Results: Preoperatively, the patients’ IOP, age, and AL, as well as their results in four Corvis ST parameters, were similar between the two groups (p > 0.05). No significant difference was observed in SP-A1; however, PD and DefAmpMax were significantly larger, and SSI was significantly smaller postoperatively in the LOT group than in the cataract group. Conclusions: Corneal stiffness was reduced, and the cornea was more deformed with LOT than cataract surgery.

Objectives: The purpose of this study was to investigate switching from brimonidine and ripasudil, and brimonidine or ripasudil, to a fixed combination of brimonidine and ripasudil, and evaluate the associated efficacy and safety in glaucoma patients. Methods: Glaucoma patients undergoing treatment with at least brimonidine and ripasudil (n = 25) or treatment with at least brimonidine or ripasudil (n = 45) were evaluated in this retrospective study. After switching patients taking brimonidine and ripasudil, or brimonidine or ripasudil, to a ripasudil/brimonidine fixed-combination, ophthalmic suspension (RBFC), intra-ocular pressure (IOP), conjunctival hyperemia and superficial punctate keratopathy (SPK) were evaluated before and at 4, 12 and 24 weeks after switching to RBFC. Results: No significant differences in the IOPs were observed after switching from brimonidine and ripasudil to RBFC. However, a significant decrease was observed at 4, 12 and 24 weeks in the baseline IOP, from 17.0 ± 4.4 mmHg to 15.7 ± 3.2 mmHg (p < 0.01), 14.3 ± 3.4 mmHg (p < 0.01) and 14.4 ± 4.1 mmHg (p < 0.01), respectively, after switching from brimonidine or ripasudil to RBFC. No significant changes were noted for the SPK score or conjunctival hyperemia score at any of the visits after switching to RBFC. Conclusions: Throughout the 24-week evaluation period, the IOP was maintained after switching from brimonidine and ripasudil to RBFC. However, there was a significant decrease in the IOP after switching from brimonidine or ripasudil to RBFC. These results demonstrate that RBFC is safe for use in the treatment of glaucoma patients.

Introduction: The use of the PreserFlo microshunt is gaining popularity owing to its ease of implantation and reduced need for postoperative intervention compared to conventional trabeculectomy. Patient concerns: However, microshunt exposure remains a severe complication of PreserFlo surgery, particularly in patients with a thin Tenon capsule and conjunctiva. However, the actual thickness and intensity of the Tenon capsule or conjunctiva can be confirmed only during surgery. Diagnosis: Exfoliation glaucoma with previous several glaucoma surgeries with thinner Tenon capsule or conjunctiva. Interventions: We performed PreserFlo implantation with a surgical technique to recover a thin Tenon capsule and conjunctiva by creating a half-thickness rectangular scleral flap under the shunt and covering it over the microshunt until the distal part, similar to the bridge. Outcomes: The patient had better intraocular pressure control with positive cosmetic appearance using this technique. Conclusion: This technique will be beneficial for both preventing exposure and holding down the top, in addition to improving cosmetic appearance.